Geoff Funk Tattoo Release

Let us do this part

Today's Date:

Fri Aug 14 2026 08:58

Practitioner:*

Photo Identification *

Please take photo(s) of your government issued photo IDs and related paperwork

Please read and answer

Customer Consent Form

To: Our Prospective Customers
Re: Geoff Funk and his employees, contractors, representatives and agents (collectively, "GFUNK")

Before a body art procedure begins, GFUNK shall obtain pertinent records and an informed consent from the client. GFUNK will request that you show your government issued identification. This information shall be kept confidential by GFUNK.

Medical History

Please tell us any of the conditions listed below that belong to you:

OTHER (including any medications for the above list)

Procedure Information

Tattoo Description/Number (What is the tattoo):

Tattoo Location On Body:

Personal Statements

READ CAREFULLY

I have been given a full opportunity to ask any and all questions about obtaining body art from GFUNK, and all of my questions have been answered to my full satisfaction. I have not been presented this package at the last minute and have had time to adequately read through it. I have received full explanation and understand the risks associated with obtaining body art, and having been informed of such risks, I still wish to obtain the body art and assume all risks that might arise from obtaining body art

I am the person on the government issued ID presented to GFUNK and I am at least 18 years of age

The information provided in this form, including my personal and medical information, is complete and true

I have previewed and accepted the body art I am to receive, and accept its design, meaning, imagery and spelling, allowing for reasonable artists' interpretation. I shall indemnify and hold harmless GFUNK from any damages, claims, solicitor's fees, or other liability arising from a breach of copyright, privacy, or trademark laws related to my body art

I am voluntarily submitting myself to receive body art without duress or coercion, and I am not under the influence of any alcohol, narcotics, or drugs

I have not consumed and narcotics within the past 24 hours

I have eaten an adequate meal within the last 3 hours

I have not consumed any alcohol in the last 8 hours

I understand the permanent nature of body art and that removal can be expensive and may leave scars on the procedure site. I understand that having the body art may impact other medical matters in the future including detecting melanom

I have been given and understand the aftercare instructions for the body art I am to receive. I acknowledge that infection is always possible as a result of obtaining body art, particularly if I do not follow the aftercare instructions. I agree that any touch-up work needed as a result of my own negligence is my own expense.

I understand that after receiving the body art I may be restricted temporarily from physical activities such as bathing, water activities, gardening and contact with animals.

I am aware of the signs and symptoms of infections, including but not limited to redness, swelling, tenderness, red streaks, elevated body temperature or pus

I have sought and received medical advice concerning obtaining body ary, or have waived the opportunity to do so. I will seek medical attention if signs and symptoms of infection occur. I do not have a physical, mental or medical impairment or disability which might affect my well-being as a result of receiving body art

I understand there is a chance I may feel lightheaded or dizzy during or after receiving the body art

I understand and accept that it is possible to have a serious allergic reaction to inks, pigments, or dyes. I have no allergies to any of soaps, metals, cosmetics, alcohol, latex. shellfish or any inks, pigments or dyes. I acknowledge that it is not reasonable for GFUNK to determine whether I may have an allergic reaction to any materials used

I will notify GFUNK immediately if I feel lightheaded or dizzy during the procedure

I understand that GFUNK may refuse to perform the body art for any reason, and may stop during the body art procedure at any time if it is deemed in GFUNK's sole discretion to be unsafe or impractical to continue

I understand that variations in colour and design may exist between any body art as selected and as applied to my body. I understand that my skin colour, scarring, eczema, psoriasis, acne, moles, freckles or other skin condition in that area determines and changes the ultimate appearance of the body art. I understand that if I have any skin treatments, laser hair removal, plastic surgery or other procedures, it may result in adverse changes to my body art. I understand sun exposure may alter the appearance of my body art.

I consent to the collection of my personal and medical information and copies of my identification

I consent to the use of videos and photos of myself and/or my body art for GFUNK's portfolio or promotional material, including in third party publications and magazines, and release my rights I may have to those photos, including any moral rights

Release

RELEASE OF LIABILITY, WAIVER OF CLAIMS, ASSUMPTION OF RISKS AND INDEMNITY AGREEMENT

BY SIGNING THIS DOCUMENT YOU WILL WAIVE CERTAIN LEGAL RIGHTS, INCLUDING THE RIGHT TO SUE

PLEASE READ CAREFULLY

TO: GEOFF FUNK and his employees, contractors, representatives and agents (collectively "GFUNK")

I HAVE SATISFIED MYSELF AND/OR WAIVED THE OPPORTUNITY TO OBTAIN INFORMATION NECESSARY TO MAKE AN INFORMED DECISION REGARDING CONSENT, AND FREELY ACCEPT AND FULLY ASSUME ALL RISKS, DANGERS, AND HAZARDS ASSOCIATED WITH PARTICIPATION IN TREATMENTS AND BODY MODIFICATION BY GFUNK AND THE POSSIBILITY OF PERSONAL INJURY DEATH, DAMAGE AND LOSS (TO EITHER PERSON AND PROPERTY) RESULTING THEREFROM

RELEASE OF LIABILITY, WAIVER OF CLAIMS, AND INDEMNITY AGREEMENT

In consideration of GFUNK performing the treatments(s) I have requested (the "Body Art"), I hereby agree as follows:
1: TO WAIVE ANY AND ALL CLAIMS that Have or may have in the future against GFUNK and TO RELEASE, INDEMNIFY AND HOLD HARMLESS GFUNK from any and all liability, loss, damage, claims, injury death or expense, whether personal or related to property, including without limitation solicitor's fees on solicitor-client full indemnity basis (and for greater clarity, regardless of whether I am successful in a claim against GFUNK or otherwise), that I may suffer, or that my next of kin may suffer as a result of my use of or presence at any GFUNK business location or arising out of any aspect of my participation in the Body Art, DUE TO ANY CAUSE WHATSOEVER, INCLUDING NEGLIGENCE, BREACH OF CONTRACT, BREACH OF WARRANTY, OR BREACH OF ANY STATUTORY OR OTHER DUTY OF CARE ON THE PART OF GFUNK;
2: TO HOLD HARMLESS AND INFEMNIFY GFNK from any and all liability, loss, damage, claims, injury, death, or expense, whether personal or related to property, including without limitation solicitor's fees on a solicitor-client full indemnity basis (and for greater clarity, regardless of whether any claim is successful against GFUNK or otherwise), that GFUNK or any third party may suffer, resulting from my use of or presence at any GFUNK business location or my participation in the Body Art;
3: I specifically acknowledge that GFUNK has not provided me with any medical advice and I have either discussed the body Art with a doctor prior to receiving the Body Art, or have waived the opportunity to do so and have satisfied that I understand and hereby accept the risks of the Body Art. I have disclaimed all prior medical conditions to GFUNK and despite having these conditions, I have satisfied myself to the associated risks and still wish to receive the Body Art;
4: This waiver shall be effective and binding upon my heirs, next of kin, executors, administrators, assigns and representatives, in the event of my death or incapacity;
5:This Agreement shall be governed by and interpreted in accordance with the laws of the Province of British Columbia, and any litigation involving the parties to this Agreement shall be brought within the Province of British Columbia.

I HAVE READ AND UNDERSTAND THIS AGREEMENT AND I AM AWARE THAT BY SIGNING THIS AGREEMENT I AM WAIVING CERTAIN LEGAL RIGHTS WHICH I MAY HAVE AGAINST GFUNK

I understand that healing finger tattoos is different to other areas on the body and may require further touch ups

If any provision, section, subsection, clause or phrase of this release is found to be unenforceable or invalid, that portion shall be severed from this contract. The remainder of this contract will then be construed as though the unenforceable portion had never been contained in this document.

Client Information

I hereby declare that I am of legal age (with valid proof of age) and am competent to sign this Agreement.

Legal Name:*

Chosen name:

Date of birth:*

You must be 18 or older

Age:

Phone #:*

Email:*

Signature:*

Sign or type signature:

Emergency Contact

If something happens, your emergency contact might need to explain your medical history, allergies, or medications.

Name:

Phone #:*